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Table 3 Physician Organization (PO) descriptions

From: Effect of care management program structure on implementation: a normalization process theory analysis

  A B C D E
Location West Michigan Mid-Michigan Southeast Michigan Southern Michigan Southeast Michigan
Number of practices visited for data collection 4 5 7 5 4
Number of practices in pilot 8 17 15 6 5
Types of practices Family Medicine (FM) FM FM & General Med/IM FM & Internal Med (IM) FM & IM
Size of practices Small (3 providers) to large (13 providers) Very small (single physician) to small (3 providers) Small (3 providers) to very large (26 providers) Very small (single physician) to large (11 providers) Medium (7 providers) to very large (37 providers)
Practice ownership Independent/ partner with PO Independent/ Hospital-owned University-owned Independent/ Hospital-owned/partner with PO Hospital-owned
Care Manager (CMgr) – Who? Nurses and Medical Assistants RNs called Health Navigators FM: part-time RNs
General Med/IM: PharmDs
Nurses (RN, LPN) and Medical assistants RNs hired specifically as case managers
CMgr location Centralized at PO/In practice Centralized at PO In practice Centralized at PO/In practice In practice
Patient mix Complex chronic disease patients; high diabetes prevalence Focuses more on prevention with patients (weight loss, smoking cessation, stress management, etc.) vs. chronic conditions FM: patients with chronic conditions such as diabetes, hypertension, etc.
General Med/IM: complex chronic disease patients, elderly, patients with medication management issues
High-risk patients (stratified high, med, low risk based on survey) Complex chronic disease patients; non-compliant patients
General CMgt in place for about 3 years due to previous grant; CMgrs attend PO learning collaborative meetings Health navigators also function in a quality improvement role;
Health navigators are able to communicate with providers via electronic medical record
2 different models within PO:
1) FM: CMgt does not seem to be a top priority;
2) General med/ IM: Pharmacists and panel managers work closely together – team approach
PO provides learning collaborative meetings-CMgrs receive education and are able to communicate with one another and share best practices Highly integrated CMgt program; PO very supportive of CMgt